Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Lung Disease

Abstract

Chronic obstructive pulmonary disease is a common, progressive disorder associated with disabling symptoms, skeletal muscle dysfunction, and substantial morbidity and mortality. Current national guidelines recommend pulmonary rehabilitation (PR) to improve dyspnea, functional capacity, and quality of life. Many PR exercise programs are based on guidelines from the American College of Sports Medicine. Recommendations have also been published by the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Thoracic Society. Translating exercise science into effective training and clinical care requires interpretation and the use of diverse national PR guidelines and recommendations. Pulmonary rehabilitation clinicians often vary in their education and background, with most nurses and respiratory care practitioners lacking formal training in exercise physiology. Patients often have comorbidities that may further complicate exercise provision and prescription. This article describes the results of an informal, nonscientific survey of the American Association of Cardiovascular and Pulmonary Rehabilitation members exploring current PR exercise prescription practices as a basis for discussion and reviews current national exercise recommendations for chronic obstructive pulmonary disease. Further, it describes areas of uncertainty regarding exercise prescription in PR and suggests strategies for providing effective exercise training, given the diversity of guidelines, clinician preparedness, and patient complexity.

Pulmonary Rehabilitation in Canada: A Report from the Canadian Thoracic Society COPD Clinical Assembly

“…It is possible that we did not identify all PR programs in recreation centres because we relied on word-ofmouth and Internet searches to identify programs in those settings. Another strength was the very high response rate of 83%, which is in contrast to the rate of 13% reported by Garvey et al (12) in the United States study. Therefore, although the absolute number of PR programs was low compared to that reported by Garvey et al (12) and Spruit et al (13), we are confident that our results are generalizable to all PR programs in Canada.…”

“…Another strength was the very high response rate of 83%, which is in contrast to the rate of 13% reported by Garvey et al (12) in the United States study. Therefore, although the absolute number of PR programs was low compared to that reported by Garvey et al (12) and Spruit et al (13), we are confident that our results are generalizable to all PR programs in Canada. This survey was very comprehensive and covered the key aspects of PR (the first section of which is reported here).…”

“…This is in contrast to PR delivery in the United States, where the majority of American Association of Cardiovascular and Pulmonary Rehabilitation-accredited programs are hospital-based (95%) with only 5% of programs in alternative locations (12). While the diversity of program locations in Canada likely increases the capacity of PR in smaller communities, there is little research investigating the safety and effectiveness of PR outside larger hospital settings where there is access to multidisciplinary teams, extensive equipment and specialist care.…”

“…To create the current survey, questions from other surveys of PR were used (9,12,13), but the scope of the survey was expanded to include 16 domains (Table 1). These domains included questions on program delivery (eg, type of program, frequency of sessions, duration); patient access and completion (eg, capacity, referral source, wait lists, completion rates and barriers to access); resources (eg, funding, equipment); health care professionals involved; aerobic and resistance exercise testing, prescription and outcomes; education topics and the use of certified respiratory educators; continuing professional development; and health care professional training needs.…”

Increasing implementation and delivery of pulmonary rehabilitation: key messages from the new ATS/ERS policy statement

“…For many others with disabling dyspnoea and significant functional limitations, the idea of participating in a programme that involves exercise training is counterintuitive and/or frightening. Overall, uptake of and participation in pulmonary rehabilitation by suitable patients remains poor [5][6][7][8]. Patients need knowledge about the health benefits of pulmonary rehabilitation and perhaps more importantly, knowledge about the ways by which pulmonary rehabilitation affords these benefits, so as to make informed decisions regarding participation.…”